Dengue Fever with Hemorrhagic Manifestations: a Report of Three Cases from Puerto Rico

Raúl H. López-CorreaSan Juan Laboratories, Bureau of Laboratories, Center for Disease Control, Public Health Service, U.S. Department of Health, Education, and Welfare, and the Veterans Administration Hospital, San Juan, Puerto Rico

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Barnett L. ClineSan Juan Laboratories, Bureau of Laboratories, Center for Disease Control, Public Health Service, U.S. Department of Health, Education, and Welfare, and the Veterans Administration Hospital, San Juan, Puerto Rico

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Carlos Ramirez-RondaSan Juan Laboratories, Bureau of Laboratories, Center for Disease Control, Public Health Service, U.S. Department of Health, Education, and Welfare, and the Veterans Administration Hospital, San Juan, Puerto Rico

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Ramón BermudezSan Juan Laboratories, Bureau of Laboratories, Center for Disease Control, Public Health Service, U.S. Department of Health, Education, and Welfare, and the Veterans Administration Hospital, San Juan, Puerto Rico

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Gladys E. SatherSan Juan Laboratories, Bureau of Laboratories, Center for Disease Control, Public Health Service, U.S. Department of Health, Education, and Welfare, and the Veterans Administration Hospital, San Juan, Puerto Rico

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Goro KunoSan Juan Laboratories, Bureau of Laboratories, Center for Disease Control, Public Health Service, U.S. Department of Health, Education, and Welfare, and the Veterans Administration Hospital, San Juan, Puerto Rico

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During the 1975 dengue epidemic in Puerto Rico, we studied three patients who had serologically confirmed dengue with hemorrhagic manifestations. None of the patients went into shock and none died. Only one of the patients had disease that resembled dengue hemorrhagic fever (DHF) as observed in Southeast Asia. This patient was a 14-year-old boy who had epistaxis, a positive tourniquet test, moderate thrombocytopenia, and significant hemoconcentration. The other two patients had hemorrhagic disease which was of clinical importance, but was not typical of DHF. These cases of dengue with hemorrhagic manifestations are the only known to have been documented in Puerto Rico.

Author Notes

San Juan Laboratories, CDC, GPO Box 4532, San Juan, Puerto Rico 00936. Send reprint requests here.

Chairman, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112.

Associate Chief of Staff for Research and Development, Veterans Administration Hospital, San Juan, Puerto Rico.

Chief, Infectious Diseases Division, VA Hospital.

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